| Objective:The present study was to evaluate the safety and efficacy of dexmedetomidine (DEX) for the prevention of EA and ED in children undergoing laparoscopic hernia repair, then to investigate the effecacy and mechanism of DEX on emergency delirium (ED) in pediatric patients undergoing cardiac surgery.Method:Part 1.One hundred children (1～5 years,10～25 kg) were randomized into (n=25/group):control group (C; saline), and three groups treated with Dexmedetomidine 0.25,0.5 and 1.0μg/kg (D1, D2 and D3, respectively). Surgery was started after intravenous infusion of Dexmedetomidine or saline within 10 min after anesthesia induction. The 5-point scale was used to evaluate EA and ED (primary endpoint). Children and Infants Postoperative Pain Scale (CHIPPS) was used within 2h postoperatively (secondary endpoint).Part 250 children of both sex aged 1～6 years (ASA II), undergoing sevoflurane-based general anesthesia for elective cardiac surgery were randomly assigned into two groups. The dexmedetomidine group (Group D, n=25) received dexmedetomidine 0.5μg/kg over 10 minutes, followed by 0.5μg/kg/h until the end of surgery, whereas the saline group (Group C, n=25) received volume-matched normal saline immediately after the induction of anesthesia. Blood samples were taken at 8:00 (preoperative day, T0, baseline),immediately after induction of anesthesia (T1), poststernotomy (3 min after sternotomy, T3), the initiation of CPB (T4), after CPB ultrafiltration (T5),3hours after operation (T6) and 8:00(the first day after surgery, T7) to determine serum melatonin (MT), cortisol (COR), Norepinephrine(NE), tumor necrosis factor-a(TNF-a), interleukin-6 (IL-6) and blood glucose levels (GLU). In Cardiac Intensive Care Unit (CICU),the incidence of EA was assessed with a 5-point scale and the severity of EA was assessed with Pediatric Anesthesia Emergence Delirium scale (PAED) every two hours for the first 24 hours after surgery. ED was considered when 5-point scale score was≥ 4 for more than 5 min or the PAED Score was> or= 10 was considered occur ED.Results:Part 1 EA frequency was 45.8%,30.4%,12% and 4% in the C, D1, D2 and D3 groups, respectively, ED frequency was 29.1%,13%,4% and 4%, respectively (all P<0.05), and CHIPPS scores were 8,6,3 and 3, respectively (P<0.05). Doses of sevoflurane were 13.21±3.36ml,12.23±3.58ml,9.47±4.12ml (P<0.05) and 9.43±3.48ml (P<0.05), respectively. Compared with group C, the time between end of anesthesia and mask removal and time for spontaneous eyes opening were significantly longer in groups D2 and D3, and TP time in postanesthesia care unit was significantly longer in group D3 (All P<0.05).Part 2 Based on comparable demographic profiles, the incidence and severity of EA were significantly lower in group D as compared to group C (P=0.028 and P=0.009, respectively). Meanwhile, the fluctuating margin of MT was significantly less in group D. And serum COR, NE, IL-6, TNF-a and GLU levels were increased in two groups but the increases were significantly less in the Group D than in the Group C. The consumption of sevoflurane during anesthesia was significantly less in the Group D than in the Group C (P=0.0002). The postoperative consumption of fentanyl was less in group D (P=0.04) while the pain scores had no significance (P=0.502). Extubation time were significantly delayed in group D than C (P=0.032) while CICU and hospital stay were quite comparable between groups.Conclusion:Part 1 Intraoperative use of dexmedetomidine significantly lowered postoperative EA and ED frequency, improved the postoperative pain score and reduced sevoflurane consumption. Dexmedetomidine 0.5μg/kg appears to be safe and efficient.Part 2 Intraoperative continuously infusion of dexmedetomidine in pediatric patients undergoing cardiac surgery decreased emergence delirium and reduced sevoflurane requirements which is associated with its decreases of the fluctuation of plasma levels of melatonin, and surgical stress. |
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